6
&
March 2014
What your
DentistKnew
Wishes You
By Dr. John M.
Falace
Recently, a patient
leaned over and
asked if I had seen
the news that “we
really don’t need to see you twice a
year anymore”. A medical doctor on a
daytime television network program
stated that six monthly visits to the
dentist are unnecessary. She smiled
and nudged me as if she were now in
on the joke.
In response to the frequent questions I get from patients about “hot
topics” in dentistry, I’d like to chime
in with my professional opinion
on some of these current issues especially since it seems that actual
dentists are rarely quoted on the TV
shows making these claims. While the
recommendations below are my professional opinion, based on clinical
experience, formal training, continuing education and research, there are
no absolute correct answers to many
of these issues, and new information
will likely change recommendations
in the future.
Amalgam silver “mercury”
fillings have been used in dentistry
for many decades. There are den-
tists that promote “metal-free” and
“mercury-free” dental practices. For
others, amalgam definitely has a place
in dental practice, particularly for
longer-lasting large fillings on molar
teeth. The controversial issue is the
fact that dental amalgam contains
toxic mercury. But, in dental amalgam, the mercury is locked within
the filling after it is placed and is not
free to escape the hardened silver
filling. Both the Food and Drug
Administration and the American
Dental Association state that available scientific evidence shows dental
amalgam is a safe and effective dental
restoration for both children and
adults. If a dentist believes amalgam
is appropriate for a given patient,
he should always ask the patient to
ensure they do not oppose the material, as there are other acceptable
options. In the right circumstances, I
believe it is an ideal filling material, as
do many others in the dental profession.
Composite resin, toothcolored restorations have become
very popular as a result of their
improved esthetic appearance and
lack of mercury. One concern is the
presence of the compound BPA in
these tooth-colored fillings (and in
dental sealants). BPA is a component
of many plastics and resins and is
found in household items such as
plastic cups, the lining of metal cans,
etc. BPA has been associated with
hormonal changes, and has some
parents concerned that exposure may
cause unwanted hormonal imbalances
in their children. From a March, 2013
ADA report: “According to manufacturers, BPA is not an added ingredient in dental composites or sealants
currently on the market.” There may
be trace amounts in some dental
products, but “the potential exposure
level is at least 100,000 times lower
than current exposure limits.” So,
according to this latest report, dental
materials should not be a cause for
concern. One recent report suggested
that during the placement of sealants on children, the dentist should
wipe a cotton gauze on the surface
of the newly placed sealant and rinse
thoroughly with water to remove
any free BPA that could potentially
exist on the surface. This seems like
good practice to be on the safe side.
I expect there will be more data to
come on this topic, but given the current evidence it appears that there is
little risk of BPA exposure from dental fillings or sealants.
The CDC proclaimed fluoride
in our drinking water as one of the
ten great public health achievements
of the 20th century. Sixty years of
evidence has shown it to be a safe
and extremely effective way to assist
in the prevention of tooth decay.
Some have expressed concern about
the association between fluoride and
certain maladies, but there is no clear
evidence of any association. BUT…
too much fluoride can cause problems with children’s developing teeth
and potentially